Index of Settlement Agreement Exhibits
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Exhibit 1 (Section A and Section B):
City’s 2007 Retiree Health Care Plan Options Booklet and the 2007 Open Enrollment Retiree Newsletter.
Exhibit 2:
The 2007 – 2008 Rate Sheets, which include but are not limited to the Rate Sheets included with the 2007 Options Booklet.
Exhibit 3:
City’s 2006 Benefits Administration Office Bulletin (Exhibit 28 in the injunction hearing and hereinafter “Bulletin”) is a term of this Agreement only as it relates to the formula to phase-in the twenty percent (20%) co-premium described in Sections V (B)(3) and (4) of the Agreement. The formula in Sections V (B)(3) and (4) shall prevail over the Bulletin, if there is any inconsistency between the Bulletin and these Sections.
Exhibit 4:
Non-duty disability letter.
Exhibit 5:
Excepted Widows/Widowers letter and attached list.
Exhibit 6:
Blue Cross Blue Shield of Michigan (BCBSM) Community Blue Group Enrollment and Coverage Agreement between the City of Detroit and BCBSM with attached benefit descriptions, DPOA CB PPO Plan, Group No. 54731-701.
Exhibit 7:
BCBSM Community Blue Group 54731-701, Benefits Certificate Form No. 6225, Preferred RX Program Certificate Form No. 3607.
Exhibit 7A:
Riders to and amending Exhibit 7.
Exhibit 7B:
Administrative Services Contract (ASC) Plan Modification 2945, Form No. 8995, modifying Exhibits 7 and 7A.
Exhibit 7C:
ASC Plan Modification 2987, Form No. 0407, modifying Exhibits 7, 7A, and 7B.
Exhibit 8:
BCBSM Comprehensive Major Medical Group No. 04436-700 (CMM) Group Enrollment and Coverage Agreementand benefit descriptions that reference Riders that amend Exhibit 8A, Comprehensive Healthcare Copayment Certificate Series (CMM 100-90/10) Form No. 5015. The Administrative Services Contract 2943 Form No. 8993, which modifies Form No. 5015 as amended.
Exhibit 8A:
BCBSM Comprehensive Major Medical Group No. 04436-700 (CMM) Healthcare Copayment Certificate Series CMM-100-90/10 Form No. 5015.
Exhibit 8B:
Prescription Drug-Rider PRX-MM Mandatory MAC Program, Form No. 6618, modifying Exhibits 8 and 8A.
Exhibit 9:
BCBSM Traditional (TRAD) Group 81100-700 and 701 Group Enrollment and Coverage Agreement
Exhibit 9A:
BCBSM TRAD Group 81100-700 and 701 Master Medical Supplemental Benefit Certificate Catastrophic Coverage Plan Option 5 (Form No. 4834), BCBSM TRAD Comprehensive Hospital Care Group Benefits Certificate (Form No. 0959), BCBSM TRAD Professional Services Group Benefit Certificate (Form No. 1879), Preferred RX Program Certificate (Form No. 3607)
Exhibit 9B:
Riders amending Exhibit 9A, as follows:
Exhibit 9C:
ASC Plan Modification 2944, Form No. 8994, modifying Exhibits 9A and 9B and Rider RM, Form No. 7562 and Rider PSA, Form No. 5140.
Exhibit 9D:
ASC Plan Modification 1862, Form No. 1395, modifying Exhibits 9A and 9B and Rider OPC, Form No. 2290, and Rider 0PPC-2, Form No. 0665.
Exhibit 10:
BCBSM Medicare Plus Blue Group Summary of Benefits, Option E (Traditional) Group No. 81100-600, 601; Option F (Community Blue) Group No. 54731-602; Option G (Comprehensive Major Medical) Group No. 04436-600,601, January 2008-December 31, 2008, revised edition.
Exhibit 11:
Blue Care Network Advantage Plan (BCN AP), 2008 Certificate of Coverage, January 1 – December 31, 2008 as amended by and including the riders:
Exhibit 12:
Blue Care Network (BCN) HMO Group No. 00102824, Group Enrollment and Coverage Agreement, BCN 5, Your Benefits, Form CB 3324 as amended by and including the Riders:
Exhibit 13:
Health Alliance Plan (HAP) HMO Group No. 1-00245 RA and RB, Summary Document HV5 07/06, and HAP HMO Subscriber Contractand Riders
Exhibit 14:
Health Alliance Plan (HAP) Senior Plus Group No. 1-0022882, 2007 Group Summary of Benefits, July 1, 2007-June 30, 2008
Exhibit 15:
U.S. Health and Life Insurance Co., Coalition of Public Safety Employees Health Trust (COPS Trust PPO Plan), Group No. 340 (06), Employee Certificate of Group Insurance Coverage, excluding both Article 5-Premiums and Notices and those provisions that address eligible class and eligibility.
Exhibit 16:
U.S. Health and Life Insurance Co., Coalition of Public Safety Employees Health Trust, (COPS Trust Traditional) Group No. 3210 (06) Employee Certificate of Group Insurance Coverage, excluding both Article 5-Premiums and Notices and those provisions that address eligible class and eligibility.
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MARTENS, ICE, KLASS, LEGGHIO & ISRAEL, P. C.
ATTORNEYS AND COUNSELORS AT LAW
306 SOUTH WASHINGTON AVENUE, SUITE 600
ROYAL OAK, MI 48067-3837
Tel: 248 398 5900; Fax: 248 398 2662
Email: dpfretireeca@martensice.com